Joshua A. Daily

Important knowledge for parents of children with heart disease: parent, nurse, and physician views

OBJECTIVES Parental understanding of their childrens heart disease is inadequate, which may contribute to poor health outcomes. The purpose of this study was to determine what parental knowledge is important in the care of children with heart disease from the perspective of parents, nurses, and physicians. METHODS Focus groups were formed with parents of children with single ventricle congenital heart disease (CHD), biventricular CHD, and heart transplantation, and with nurses and physicians who provide care for these children. A nominal group technique was used to identify and prioritise important parental knowledge items and themes. The voting data for each theme were reported by participant type--parent, nurse, and physician--and patient diagnosis--single ventricle CHD, biventricular CHD, and heart transplantation. RESULTS The following three themes were identified as important by all groups: recognition of and response to clinical deterioration, medications, and prognosis and plan. Additional themes that were unique to specific groups included the following: medical team members and interactions (parents), tests and labs (parents), neurodevelopmental outcomes and interventions (physicians), lifelong disease requiring lifelong follow-up (physicians and nurses), and diagnosis, physiology, and interventions (single ventricle and biventricular CHD). CONCLUSIONS Parents, nurses, and physicians have both common and unique views regarding what parents should know to effectively care for their children with single ventricle CHD, biventricular CHD, or heart transplantation. Specific targeted parental education that incorporates these findings should be provided to each group. Further development of questionnaires regarding parental knowledge with appropriate content validity is warranted.

The journey to becoming an adult learner: from dependent to self-directed learning.

“Half of what you’ll learn in medical school will be shown to be either wrong or out of date within 5 years of graduation; the trouble is that nobody can tell you which half, so the important thing to learn is how to learn on your own.” —David L. Sackett, OC, MD [(1)][1] This statement by

Appropriateness and diagnostic yield of inpatient pediatric echocardiograms

OBJECTIVE Multiple reports have shown echocardiograms for certain indications are neither cost-effective nor of high diagnostic yield. Given the ease with which tests can be obtained at a tertiary academic childrens hospital, our aims were to: (1) determine the diagnostic yield of inpatient studies by in-hospital location; (2) evaluate inpatient echocardiograms to determine indications and level of appropriateness; and (3) evaluate the frequency of cardiology involvement prior to those echocardiograms. DESIGN All initial inpatient echocardiograms interpreted at our institution from February 2009 to December 2014 were reviewed retrospectively. Patient location was grouped as pediatric intensive care (PICU), emergency department (ED), and general floor. RESULTS There were 727 first-time inpatient echocardiograms that met inclusion criteria. Pathology was identified in 25% of the study echocardiograms, with 11% of all studies demonstrating pathology that could alter patient management (moderate or severe pathology). The studies performed in the PICU and ED had more severe pathology compared with those from the general floor (P < .001, .003; respectively). Few echocardiograms were performed for rarely appropriate indications on the general floor (7%) and PICU (2.2%). Over 75% of general floor echocardiograms performed for a pathologic murmur yielded normal or incidental findings. Cardiology consultation was documented in only 7.5% of general floor studies. CONCLUSION The diagnostic yield of inpatient, first-time pediatric echocardiograms is relatively low. The majority of studies that identified pathology were performed on patients located in higher acuity units. General floor echocardiograms for murmurs had a low diagnostic yield, raising the question of cardiology consultation versus direct echocardiogram ordering for subjective physical exam signs.

Is Magnet® recognition associated with improved outcomes among critically ill children treated at freestanding children's hospitals?

Purpose: With increasing emphasis on high‐quality care, we designed this study to evaluate the relationship between Magnet® recognition and patient outcomes in pediatric critical care. Materials and methods: Post hoc analysis of data from an existing administrative national database. We used inverse probability of treatment weighting and multivariate models to compare outcomes between two study groups after adjusting for confounding variables. Results: A total of 823,634 pediatric patients from 41 centers were included. Of these, 454,616 patients (55.2%) were treated in 23 Magnet hospitals. The majority of baseline characteristics did not vary significantly among the two study groups. In adjusted models, there was no difference in mortality between the two groups (Magnet vs. non‐Magnet; odds ratio: 0.92, 95% confidence interval: 0.77–1.11). When stratified by various subgroups, such as cardiac, non‐cardiac, ECMO, cardiac arrest, respiratory failure, use of nitric oxide, genetic abnormality etc., Magnet status of the hospital did not confer a survival advantage. In a sensitivity analysis on patients from crossover hospitals only, attainment of magnet status was associated with increased hospital charges. Conclusions: This large observational study calls into question the utility of the Magnet Recognition Program among children with critical illness, at least among the freestanding childrens hospitals. Highlights:We evaluated the impact of Magnet recognition on patient outcomes.There was no difference in mortality between the two groups.Magnet status was associated with increased hospital charges.This study calls into question the utility of the Magnet Program.

Teaching pediatric cardiology with meaning and sense

Pediatric cardiologists teach complicated concepts to a diverse group of learners that include medical students, nurses, residents, fellows, patients, and parents. Unfortunately, much of what is taught is not retained. In order to increase the likelihood of long-term retention, a cardiologist should teach with both meaning and sense. The authors provide a review of these concepts and give specific examples of how to teach in ways that both make sense and are meaningful to a cardiologists leaners.

The Quest to Become a Master Teacher: One Cardiologist's Story and Recommendations for Others.

“Education is the most powerful weapon which you can use to change the world.”—Nelson Mandela [(1)][1] This famous quotation stands in stark contrast to the words of a senior cardiologist whom I worked with as a fellow: “Teaching just isn’t really that impactful. If you really want to

Learning in Cardiology Fellowship: Opportunities for Optimization

Cardiology fellowship is filled with opportunities for learning; however, numerous obstacles must be successfully navigated to complete training with the knowledge, skills, and attitudes necessary for a successful career. To assist Cardiology fellows in prioritizing their time and energy in order to fully gain from their training, a list of recommendations with rationales has been provided.

Management of a child with pulmonary arterial hypertension presenting with systemic hypertension.

We describe the course and management of a 12-year-old girl with severe pulmonary arterial hypertension who initially presented with severe systemic hypertension. Successful therapy included pulmonary vasodilators and an atrial septostomy, while ensuring adequate maintenance of her systemic vascular resistance to maintain cardiac output. Clear understanding of the physiology and judicious medical management in patients with severe pulmonary arterial hypertension using extreme compensatory mechanisms is vitally important.

Transcatheter Versus Surgical Pulmonary Valve Replacement in Repaired Tetralogy of Fallot

Transcatheter pulmonary valve replacement (TC-PVR) is an alternative to surgical PVR (S-PVR) in repaired Tetralogy of Fallot (TOF). The purpose of this study is to compare in-hospital outcomes, hospital costs, and projected 5-year total costs of S-PVR to TC-PVR in patients with repaired TOF. We performed a multicenter, retrospective cohort study of children and adults with TOF ≥ 8 years of age who underwent PVR from January 1, 2010 to December 31, 2016 at 46 centers contributing to the Pediatric Health Information Systems database. Baseline characteristics, in-hospital outcomes, and costs were compared between the two groups. Projected 5-year costs were calculated by combining cost data with published reintervention rates. A total of 194 TC-PVR and 1,072 S-PVR were performed. The baseline characteristics of the TC-PVR and S-PVR groups were not significantly different with the exception of greater age in the TC-PVR group (median age of 17 years vs 15 years, p value <0.001). Discharge mortality, hospital charges and estimated cost, surgical complication rates, and acute kidney failure were not significantly different between the groups. Intensive care unit use, intensive care unit length of stay (LOS), mechanical ventilation use, extracorporeal membrane oxygenation use, and total LOS were lower with TC-PVR than S-PVR. Projected 5-year costs were greater with TC-PVR compared with S-PVR (

Cardiomyopathy With Restrictive Physiology in Sickle Cell Disease

64,762 vs